Payment for vision screening (99173) is not easy, but reimbursement is straightforward for the VEP (Visual evoked potential testing central nervous system, checkerboard or flash), when using a VEP machine (CPT 95930). The VEP machine test is for amblyopia in children as young as 6 months old.
The result of a VEP test (95930) is a readable analysis that identifies any asymmetries from the front of the eye to the visual cortex. The test also analyzes the visual EEG component and compares each eye’s function.
The American Academy of Pediatrics guidelines recommend that children have an early childhood vision screening test at age 3-4 years. VEP testing allows the physician an objective assessment of a child’s vision for appropriate referral, diagnosis, and treatment.
Most payers will reimburse the VEP test 80% of the time depending on the specific payer mix. Medicare allows approximately $108 for 95930 nationally. Commercial payer’s reimbursement ranges from $60-$160. Most State Medicaid carrier’s reimbursement ranges from $30-$90.
It is also important to use the appropriate diagnosis code when billing for 95930:
V20.2 – Routine infant or child health check
V80.8 - Special screening for neurological eye conditions
794.13 - Abnormal VEP Test - if a child tests normal (negative), you would bill 95930 with the sign, symptom, condition that prompted the test and V80.2
Payers do recognize the importance of early vision testing.
* Remember that all 2009 ICD-9 codes are effective October 1, 2008.
If you need any additional information on this article or Coding & Compliance services, please contact Cindy Tipton at Cindy_Tipton@MED3000.com
For a printable version, click: CCNewsletterSeptember2008
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